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Respiratory Care Sep 2019Noninvasive respiratory support refers to strategies aimed at providing oxygenation and/or ventilation without the use of an artificial airway. These strategies include... (Review)
Review
Noninvasive respiratory support refers to strategies aimed at providing oxygenation and/or ventilation without the use of an artificial airway. These strategies include the use of standard oxygen delivery devices (face masks, low-flow nasal cannulas), noninvasive ventilation, and high-flow nasal cannula. Considerable interest has been generated recently as to which therapy provides the optimum noninvasive support. This review examined the important literature related to noninvasive respiratory support published in 2018.
Topics: Humans; Noninvasive Ventilation; Oxygen Inhalation Therapy
PubMed: 31467154
DOI: 10.4187/respcare.07170 -
Respiratory Care Oct 2018
Topics: Humans; Insufflation; Neuromuscular Diseases; Respiratory Therapy
PubMed: 30237280
DOI: 10.4187/respcare.06542 -
Respiratory Care Jun 2017This article reviews the common pulmonary complications seen in the pediatric oncology population and our approach to diagnosis, management, and therapy considerations... (Review)
Review
This article reviews the common pulmonary complications seen in the pediatric oncology population and our approach to diagnosis, management, and therapy considerations in this specialized population, including patients receiving chemotherapy, radiation, and hematopoietic stem cell transplantation. Although infections cause the most significant complications in this population, non-infectious complications, including acute lung injury from chemotherapy or radiation, idiopathic interstitial pneumonia, diffuse alveolar hemorrhage, bronchiolitis obliterans, and cryptogenic organizing pneumonia, also occur commonly. With improvements in survival of childhood cancer, there are now a growing number of adults who are childhood cancer survivors who may be encountered by therapists in adult hospitals. We also review the growing literature on the emerging late pulmonary findings in these adult childhood cancer survivors.
Topics: Adult; Cancer Survivors; Child; Humans; Long Term Adverse Effects; Neoplasms; Respiration Disorders; Respiratory Therapy
PubMed: 28546377
DOI: 10.4187/respcare.05223 -
Critical Care Clinics Jul 2022High-flow nasal oxygen (HFNO) and noninvasive ventilation (NIV) via facemask or helmet have been increasingly used in managing acute hypoxemic respiratory failure (AHRF)... (Review)
Review
High-flow nasal oxygen (HFNO) and noninvasive ventilation (NIV) via facemask or helmet have been increasingly used in managing acute hypoxemic respiratory failure (AHRF) owing to COVID-19 with the premise of reducing the need for invasive mechanical ventilation and possibly mortality. Their use carries the risk of delaying intubation and nosocomial infection transmission. To date, most studies on the effectiveness of these modalities are observational and suggest that HFNO and NIV have a role in the management of AHRF owing to COVID-19. Trials are ongoing and are evaluating different aspects of noninvasive respiratory support in patients with AHRF owing to COVID-19.
Topics: COVID-19; Humans; Noninvasive Ventilation; Oxygen; Oxygen Inhalation Therapy; Respiration, Artificial; Respiratory Insufficiency
PubMed: 35667746
DOI: 10.1016/j.ccc.2022.01.006 -
Respiratory Care Mar 2017
Topics: Delivery of Health Care; Humans; Respiratory Therapy
PubMed: 28246282
DOI: 10.4187/respcare.05484 -
The Kaohsiung Journal of Medical... Oct 2020Mechanical ventilation (MV) is a common life support system in intensive care units. Accurate identification of patients who are capable of being extubated can shorten...
Mechanical ventilation (MV) is a common life support system in intensive care units. Accurate identification of patients who are capable of being extubated can shorten the MV duration and potentially reduce MV-related complications. Therefore, prediction of patients who can successfully be weaned from the mechanical ventilator is an important issue. The electronic medical record system (EMRs) has been applied and developed in respiratory therapy in recent years. It can increase the quality of critical care. However, there is no perfect index available that can be used to determine successful MV weaning. Our purpose was to establish a novel model that can predict successful weaning from MV. Patients' information was collected from the Kaohsiung Medical University Hospital respiratory therapy EMRs. In this retrospective study, we collected basic information, classic weaning index, and respiratory parameters during spontaneous breathing trials of patients eligible for extubation. According to the results of extubation, patients were divided into successful extubation and extubation failure groups. This retrospective cohort study included 169 patients. Statistical analysis revealed successful extubation predictors, including sex; height; oxygen saturation; Glasgow Coma Scale; Acute Physiology and Chronic Health Evaluation II score; pulmonary disease history; and the first, 30th, 60th, and 90th minute respiratory parameters. We built a predictive model based on these predictors. The area under the curve of this model was 0.889. We established a model for predicting the successful extubation. This model was novel to combine with serial weaning parameters and thus can help intensivists to make extubation decisions easily.
Topics: Aged; Aged, 80 and over; Electronic Health Records; Female; Humans; Intensive Care Units; Male; Middle Aged; Respiration, Artificial; Retrospective Studies; Ventilator Weaning
PubMed: 32729992
DOI: 10.1002/kjm2.12269 -
Respiratory Care Aug 2021In patients with cystic fibrosis (CF), despite the availability of many different pharmacologic agents, lung function deteriorates and lung disease progresses and leads... (Review)
Review
In patients with cystic fibrosis (CF), despite the availability of many different pharmacologic agents, lung function deteriorates and lung disease progresses and leads to hypercapnic respiratory failure in some patients. In such cases, noninvasive ventilation (NIV) seems to be a promising technique that can be used on demand. This review summarizes the current applications of NIV in clinical settings as well as findings of the clinical trials that involved the delivery of NIV on variable occasions, such as an adjunct to physiotherapy, in nocturnal hypoventilation, and acute and chronic respiratory failure. NIV has been used in patients with CF and with advanced lung disease who are not considered candidates for lung transplantation. It can stabilize lung function, although its effect on hypercapnia is not always evident. Nocturnal NIV has been used in patients with CF and with hypoventilation during sleep but without clear benefits on daytime [Formula: see text] NIV as an adjunct to chest physiotherapy may be helpful when desaturation is observed during physiotherapy and when there are signs of respiratory muscle fatigue. NIV use in CF has been increasing, mainly in adult CF centers, and offers patients an opportunity to reach lung transplantation or to overcome acute hypercapnic respiratory failure.
Topics: Adult; Cystic Fibrosis; Humans; Hypercapnia; Hypoventilation; Noninvasive Ventilation; Respiratory Insufficiency; Respiratory Therapy
PubMed: 34035149
DOI: 10.4187/respcare.08755 -
American Journal of Physical Medicine &... Sep 2020This analysis extrapolates information from previous studies and experiences to bring physical medicine and rehabilitation perspective and intervention to the... (Review)
Review
This analysis extrapolates information from previous studies and experiences to bring physical medicine and rehabilitation perspective and intervention to the multidisciplinary treatment of COVID-19. The purpose of pulmonary rehabilitation in COVID-19 patients is to improve symptoms of dyspnea, relieve anxiety, reduce complications, minimize disability, preserve function, and improve quality of life. Pulmonary rehabilitation during the acute management of COVID-19 should be considered when possible and safe and may include nutrition, airway, posture, clearance technique, oxygen supplementation, breathing exercises, stretching, manual therapy, and physical activity. Given the possibility of long-term disability, outpatient posthospitalization pulmonary rehabilitation may be considered in all patients hospitalized with COVID-19.
Topics: Betacoronavirus; COVID-19; Coronavirus Infections; Humans; Pandemics; Physical and Rehabilitation Medicine; Pneumonia, Viral; Respiratory Therapy; SARS-CoV-2; Subacute Care
PubMed: 32541352
DOI: 10.1097/PHM.0000000000001505 -
Respiratory Care Mar 2017Respiratory therapist (RT)-driven protocols have been in use for over 30 years. Protocols have been reported to decrease unnecessary or harmful therapy, health-care...
BACKGROUND
Respiratory therapist (RT)-driven protocols have been in use for over 30 years. Protocols have been reported to decrease unnecessary or harmful therapy, health-care costs, and hospital stay. This study represents the evaluation of an original respiratory care protocol in the pediatric ICU at Arkansas Children's Hospital for β-agonist and airway clearance interventions where one did not exist.
METHODS
This project was composed of 2 parts: a survey administered to RTs and licensed independent practitioners and a retrospective review of outcome data comparing a therapist-driven β-agonist/airway clearance protocol with physician-directed respiratory care ordering in a patient population admitted for acute respiratory failure.
RESULTS
Acceptance of the protocol was evident in the survey responses because overall perceptions surrounding the implementation of the β-agonist/airway clearance protocol were positive, and responders perceived that the protocol implementation elevated the status and increased the value of respiratory therapists. For the comparison of physician-directed orders with therapist-driven protocols, there were no significant differences between pre- and post-intervention groups for mean age, sex, mean daily acuity, or mean weighted daily acuity ( = .33, .19, >.99, and .79, respectively). There were also no differences in pediatric index of mortality 2, pediatric index of mortality 2 rate of mortality, pediatric risk of mortality 3 probability of death, and pediatric risk of mortality 3 scores ( = .63, .56, .19, and .44, respectively) between the 2 groups. When comparing physician-directed orders to therapist-driven protocols, all outcome measures (length of stay, β-agonist therapies, airway clearance therapies, and ventilator days) showed statistically and clinically important reductions, adjusting for subject characteristics ( < .001) for the therapist-driven protocol group.
CONCLUSIONS
In this institution, implementation of a β-agonist/airway clearance protocol resulted in significant reductions of subject interventions and improved outcomes by decreasing length of stay and ventilator days as well as contributing information where clinical evidence is scant, specifically the pediatric ICU.
Topics: Child; Child, Preschool; Clinical Protocols; Female; Health Plan Implementation; Humans; Intensive Care Units, Pediatric; Length of Stay; Male; Respiratory Insufficiency; Respiratory Therapy; Retrospective Studies; Treatment Outcome
PubMed: 28028189
DOI: 10.4187/respcare.04857 -
Pneumologie (Stuttgart, Germany) Nov 2014The cornerstone of drug application in obstructive pulmonary diseases is by inhalation as advocated by all treatment guidelines. Today, there exists an extensive choice... (Meta-Analysis)
Meta-Analysis Review
The cornerstone of drug application in obstructive pulmonary diseases is by inhalation as advocated by all treatment guidelines. Today, there exists an extensive choice of inhalers and new models. Numerous inhaler types are constantly being developed and introduced into the market making the "correct" selection a wearying task for the physician as well as for the patient. Improvement in the management of this aspect, which is often neglected in its importance in daily practice as well as in guidelines, is therefore reliant not only on the medications themselves but also on their effective delivery. Complicated inhaler mechanics and poor inhaler technique which do not meet the patient requirements and desires contribute to poor compliance eventually leading to poor disease control. In this review, the importance of inhaler acceptance and the degree of satisfaction with different inhaler types are discussed. This paper focuses on the behavioral and attitudinal evidence that the acceptance of the inhaler is linked to patient compliance, and its linkage on health and patient-reported outcomes.
Topics: Bronchodilator Agents; Evidence-Based Medicine; Humans; Medication Adherence; Metered Dose Inhalers; Patient Satisfaction; Prevalence; Pulmonary Disease, Chronic Obstructive; Respiratory Therapy; Treatment Outcome
PubMed: 25229316
DOI: 10.1055/s-0034-1377573